Recently, digital radiography and fluoroscopy techniques have been developed. In digital radiography, a source of x-radiation is actuated to direct a beam of radiation through a patient's body to a detector in the beam path beyond the patient. The detector, by use of appropriate sensor means, responds to incident radiation to produce analog signals representing the sensed radiation image, which signals are converted to digital information and fed to a digital data processing unit. The data processing unit records, and/or processes and enhances the digital data. A display unit responds to the appropriate digital data representing the image to convert the digital information back into analog form and produce a visual display of the patient's internal body structure derived from the acquired image pattern of radiation emergent from the patient's body. The display system can be coupled directly to the digital data processing unit for substantially real time imaging, or can be fed stored digital data from digital storage means such as tapes or discs representing patient images from earlier studies.
Digital radiography includes radiographic techniques in which a thin fan beam of x-radiation is used, and other techniques in which a more widely dispersed so-called "area beam" is used. In the former technique, often called "scan (or slit) projection radiography" (SPR) a fan beam of x-radiation is directed through a patient's body. The fan is scanned across the patient, or the patient is movably interposed between the fan beam x-ray source and an array of individual cellular detector segments which are aligned along an arcuate or linear path. Relative movement is effected between the source-detector arrangement and the patient's body, keeping the detector aligned with the beam, such that a large area of the patient's body is scanned by the fan beam of x-rays. Each of the detector segments produces analog signals indicating characteristics of the received x-rays.
These analog signals are digitized and fed to a data processing unit which operates on the data in a predetermined fashion to actuate display apparatus to produce a display image representing the internal structure and/or condition of the patient's body.
In use of the "area" beam, a divergent beam of x-radiation is directed through the patient's body toward the input face of an image intensifier tube positioned opposite the patient with respect to the source. The tube output face is viewed by a television camera. The camera video signal is digitized, fed to a data processing unit, and subsequently converted to a viewable representation of the patient's internal body structure or condition.
One of the advantages of digital radiography and fluoroscopy is that the digital image information generated from the emergent radiation pattern incident on the detector can be processed, more easily than analog data, in various ways to enhance certain aspects of the image, to make the image more readily intelligible and to display a wider range of anatomical attenuation differences.
An important technique for enhancing a digitally represented image is called "subtraction". There are two types of subtraction techniques, one being "temporal" subtraction, the other "energy" subtraction.
Temporal, sometimes called "mask mode" subtraction, is a technique that can be used to remove overlying and underlying structures from an image when the object of interest is enhanced by a radiopaque contrast agent, administered intra-arterially or intra-venously. Images are acquired with and without the contrast agent present and the data representing the former image is subtracted from the data representing the latter, substantially cancelling out all but the blood vessels or anatomical regions containing the contrast agent. Temporal subtraction is, theoretically, the optimum way to image the enhancement caused by an administered contrast agent. It "pulls" the affected regions out of an interfering background.
A principle limitation of digital temporal subtraction is the susceptibility to misregistration, or "motion" artifacts caused by patient movement between the acquisition of the images with and without the contrast agent.
Another disadvantage of temporal subtraction is that it requires the use of a contrast material and changes in the contrast caused by the agent must occur rapidly, to minimize the occurrence of motion caused artifacts by reducing the time between the first and second exposure acquisition. Temporal subtraction is also not useful in studies involving rapidly moving organs such as the heart. Also, the administration of contrast agents is contraindicated in some patients.
An alternative to temporal subtraction, which is less susceptible to motion artifacts, is energy subtraction. Whereas temporal subtraction depends on changes in the contrast distribution with time, energy subtraction exploits energy-related differences in attenuation properties of various types of tissue, such as soft tissue and bone.
It is known that different tissues, such as soft tissue (which is mostly water) and bone, exhibit different characteristics in their capabilities to attenuate x-radiation of differing energy levels.
It is also known that the capability of soft tissue to attenuate x-radiation is less dependent on the x-ray's energy level than is the capability of bone to attenuate x-rays. Soft tissue shows less change in attenuation capability with respect to energy than does bone.
This phenomenon enables performance of energy subtraction In practicing that technique, pulses of x-rays having alternating higher and lower energy levels are directed through the patient's body. When a lower energy pulse is so generated, the detector and associated digital processing unit cooperate to acquire and store a set of digital data representing the image produced in response to the lower energy pulse. A very short time later, when the higher energy pulse is produced, the detector and digital processing unit again similarly cooperate to acquire and store a set of digital information representing the image produced by the higher energy pulse. The values obtained representing the lower energy image are then subtracted from the values representing the higher energy image.
Since the attenuation of the lower energy x-rays by the soft tissue in the body is approximately the same as soft tissue attenuation of the higher energy x-rays, subtraction of the lower energy image data from the higher energy image data approximately cancels out the information describing the configuration of the soft tissue. When this information has been so cancelled, substantially all that remains in the image is the representation of bone. In this manner, the contrast and visibility of the bone is substantially enhanced by energy subtraction.
Energy subtraction has the advantage, relative to temporal subtraction, of being substantially not subject to motion artifacts resulting from the patient's movement between exposures. The time separating the lower and higher energy image acquisitions is quite short, often less than one sixtieth of a second.
Details of energy subtraction techniques in digital radiography and fluoroscopy are set forth in the following technical publications, all of which are hereby incorporated specifically by reference:
Hall, A. L. et al: "Experimental System for Dual Energy Scanned Projection Radiology". Digital Radiography Proc. of the SPIE 314: 155-159, 1981; PA0 Summer, F. G. et al: "Dual Energy Radiography: a Preliminary Study". Digital Radiography Proc. SPIE 314: 181-182, 1981; and PA0 Lehman, L. A. et al: "Generalized Image Combinations in Dual kVp Digital Radiography", Medical Physics 8: 659-667, 1981.
Dual energy subtraction has been accomplished, as noted above, by pulsing an x-ray source in a digital scanning slit device at two kVp's, typically 120 and 80 kVp, and synchronizing the pulses with a rotating filter which hardens the high kVp pulses by filtering out the lower energy x-rays. This results in the patient and x-ray detector sequentially seeing high energy and low energy beams from which the mass per unit area of bone and soft tissue can be solved for.
In energy subtraction, it is desirable that the two energy levels should be widely separated. This is necessary in order to accurately define the masses per unit area of bone and soft tissue.
With a slit scanning device, such as described above, sequentially pulsing the x-ray tube at 120 and 80 kVp is technically difficult and gives rise to very difficult problems in a practical clinical device. The switching frequency has to be on the order of 60 Hz. and insufficient photons (x-ray energy per pulse) results when the highest capacity x-ray tubes are combined with realistically narrow slit widths and scanning times.
In connection with CT (computerized tomography) applications, a two layer energy sensitive detector has been proposed. In this proposal, a first calcium fluoride layer is provided for sensing lower level x-ray radiation, and a second downstream sodium iodide layer senses higher energy radiation passing through the first layer. Light caused by radiation in each of the two layers is separately sensed by respective photomultiplier tubes.
In order to overcome these technical difficulties, an energy discriminating dual layer split energy radiation detector for use in digital radiography and fluoroscopy has been proposed and is described in U.S. Pat. No. 4,626,688, issued Dec. 2, 1986 to Gary T. Barnes, which is herein expressly incorporated by reference.
The detector described in this United States patent employs a low atomic number phosphor screen or discrete array of phosphor elements coupled to a photodiode array, followed by a high atomic number phosphor screen or discrete segment array similarly coupled. The low atomic number phosphor preferentially absorbs lower energy radiation, while allowing the higher energy radiation in large measure to pass through and to fall incident on the higher atomic number screen, which absorbs preferentially the higher energies.
A filter is suggested between the layers, having a primary absorber element having an atomic number from 24 to 58.
In order to optimize the energy discriminating capability of the detector proposed by Barnes, optimal material selection, coating weights and detector configuration as in the present invention are disclosed.